| NPI | 1356779573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM JERNBERG President 469-401-2386 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2013-10-25 |
| Last Update Date | 2013-12-10 |